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Standards – The main game in eHealth

Standards – The main game in eHealth. David Rowlands Elizabeth Hanley. Agenda. Introductions Standards - What and why? Standards – Who and how? Standards development work program New challenges and issues. Standards?.

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Standards – The main game in eHealth

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  1. Standards – The main game in eHealth David Rowlands Elizabeth Hanley

  2. Agenda • Introductions • Standards - What and why? • Standards – Who and how? • Standards development work program • New challenges and issues

  3. Standards? A Standard is a published document which sets out specifications and procedures designed to ensure that a material, product, method or service is fit for its purpose and consistently performs in the way it was intended.

  4. Types of standards • Units and measures – e.g. a metre… • Technologies and systems – e.g 240 volts, GSM, VHS/Beta, HD DVD/Blu Ray • Performance based – e.g. fire burn through times, impact absorption (bicycle helmets) • Management based – e.g quality and risk • Interchange formats – e.g. HL7, STEP

  5. Types of standards • De facto – what the market adopts (e.g. the QWERTY keyboard); or what a market dominator supplies… • Regulatory – what regulators specify (e.g. aged care assessment standards) • Consensus – voluntary standards developed via neutral agencies such as Standards Australia

  6. Benefits of standards • Protection – safety and confidence • Innovation – technology/best practice diffusion • Productivity and growth • Competitive edge, support for competition • “Red tape” reduction

  7. Innovation? • Standards can be productivity aids or inhibitors – e.g. the QWERTY keyboard • They enable technology diffusion • And the relationship between standards and innovation is often very interlinked – e.g. Boeing and STEP

  8. Productivity & growth? • One third of Germany’s economic growth over the period 1960-96 is attributed to standards – “Standards are at least as important as patents for growth” • See WTO report - http://www.wto.org/english/res_e/booksp_e/anrep_e/wtr05-2a_e.pdf • Australian Standards generate benefits of between $24 million and $100 million per year (research submission to Productivity Commission)

  9. Standards in Health IT? • What’s the problem? • How are we addressing it? • Why standards? • Challenges and issues • Whose problem, whose challenges?

  10. The problem? Chronic conditions requiring coordinated care A sustainable health system that is accessible to all A safe, high quality health system Rising demand and cost structures, limited resources Recognition that error is as systematic as success Good health outcomes by international standards Measurement

  11. The solutions? • A more connected health service delivery system – e.g. chronic disease management strategies • Evidence-based (standards-based?) delivery systems • Measurement; cost containment • Better use of information and knowledge • With dependencies on the flow of information – to enhance safety and quality; to enable more efficient markets

  12. Reliance on “External” Data and Knowledge is Increasing 120 Infomediaries Emerge 90 Third- Party Sites External Customer Data Terabytes of Data Merged Data 60 Internal Data Company Web Site 30 Syndicated Data MarketingDatabase DataWarehouse 1989 1994 1999 2004 Source: Gartner Group

  13. Health ICT goals? • Support systemic approaches, within and between organisations, by delivering interoperability and interconnection capabilities • Enable market efficiency by providing a common technical framework for e-health application development, procurement and implementation • Support knowledge and information management

  14. Health ICT benefits • CITL - $US60 billion per annum in the USA • Schloeffel - $A3.7 billion in Australia • Sprivulis – 4.1% of the expenditure by Australian Governments on healthcare • Georgeff - improved knowledge sharing & care plan management for patients with chronic disease would produce direct health care savings of over $1.5 billion per year

  15. Standards or adapters • Adapters – work best when there are blocks of standardisation • E.g. the power adapter • The interface engine • Standards – work best when there is too much diversity for adapters to be feasible • As in health • A mix is not uncommon

  16. Standards? • Most countries have recognised the need for health informatics standards to support health system reform • And are investing in them • As a necessary but not sufficient contributor • But there are a range of other reasons why developers and implementers should be interested in standards (e.g. the Boeing example)

  17. Health informatics standards • IT-014 is Standards Australia’s Health Informatics Technical Committee • IT-014 has published or is in the process of publishing 75 standards/specifications/ guidelines/reports • 41 about implementing HL7 in Australia • 11 about supply chain messaging • 11 about security and identity management • Another 40 projects in 2007-08? • Other IT standards also apply to health (e.g. IT governance, security)

  18. Who’s who? HDSC/SIMC Consistency between standards; create once, use often; sustainable implementability allowing interoperability IT-14 Data standards – development & implementation, primarily within Government Development of technical standards HL7 NeHTA Development of technical standards; implementation support Consistent implementation of standards and directories to promote sectoral efficiency & effectiveness

  19. Who’s who? HDSC/SIMC IT-14 Data standards – development & implementation, primarily within Government Development of technical standards, including HL7 eHealth Standards Forum, Working Agreements, cross memberships HL7 Australia NeHTA Implementation support Consistent implementation of standards and directories to promote sectoral efficiency & effectiveness

  20. Who’s who (part 2)? • International – HL7, ISO, CEN • Industry collaboratives – W3C, WSI, OMG, Continua,.. • Very important to Australia: • We are a small market that imports health software from multinational vendors – the assimilation problem • With small local companies trying to export into global markets

  21. International • Participation is vital • These are lobbying bodies • Clear objectives required • We are international leaders • See international standards reports at www.e-health.standards.org.au/

  22. Questions/comments • Questions/comments at this stage? • To come: • Standards development in 2007-08 • Challenges and issues

  23. 2007-08(subject to funding) • Identification: • Revision of Australian client ID standard • International provider ID standard • Messaging & communication: • HL7 version 2 compatibility guide • Specifications for digital signature in healthcare messages • HL7 V2 messages for scheduling clinical events; bed availability • Carriage of archetyped data in HL7 V2 diagnostic and collaborative care messages • Upgrades to & conformance criteria for HL7 V2 diagnostic messaging • NEHTA leading in service and CDA specifications for pathology and collaborative care

  24. 2007-08(subject to funding) • Telehealth: • Session information for health records • Specifications for data produced by personal monitoring devices • Electronic decision support: • Investigation of standards requirements • Standardised self-populating electronic document

  25. 2007-08(subject to funding) • International: • HL7/OMG Health Service Specifications • CEN/ISO Health Informatics Service Architecture • Harmonised data types for e-health interoperability • Progression of the HL7 EHR-S Functional Model into an ISO Standard • HL7 EHR interoperability and life cycle models • Review of AS/ISO18308: Requirements for EHR architecture • Australian position on ISO/CEN 13606: EHR communication • Requirements for health summary records • Harmonisation of standards for clinical models

  26. 2007-08(subject to funding) • International (continued): • Pseudonymisation • Scoping of needs for standards for personal health IT, including personal health records • Privilege Management and Access Control • Good practice in term set development and terminology mapping • Risks associated with health software • ISO Pharmacy and Medication work items • Deployment of clinical data warehouses

  27. Issues and challenges • Some perspectives… • The speed of standards development is “glacial • The system of standards development takes too long to understand and operate effectively within • The value of participation is not clear to the outside world (particularly potential funders) • Participation is falling • Many potential participants are priced out of the game by the assumption that ability/willingness to pay is a reliable proxy for interest

  28. Issues and challenges • Some perspectives… • The ICT marketplace has changed - greater competition and overlap; monolithic approaches supplanted by heterogeneous technology development; shift from hardware to software; speed. • These imply a shift from traditional standardisation to products with short-term development/exploitation cycles; creates parallel routes to standards • Implementation of standards is inconsistent • We also have fusion of standards

  29. Issues and challenges • These quotes are not about health informatics; they are referring to standards development across the board; they originate from inside and outside Australia • There are much wider issues at play here

  30. Responses • More consistent implementation: • NEHTA’s standards implementation initiative • Certification and conformance • Active networking (e.g. through HL7) • Availability – free downloads (thanks DoHA!) • Ensure standards development is fed by implementation requirements and feedback • Means being involved • We are seeking more active participation

  31. Responses • Participation/more balanced representation: • Web meetings, tele- & video-conferencing; e-health standards portal • Speed of development: • contracted drafting (thanks DoHA) • Partnering: • With HL7, NEHTA, jurisdictions, major projects

  32. Funding? • Standards development is resourced by: • Government grants (DoHA) • Participants volunteering their time and effort • Productivity Commission has encouraged Government support • Same arguments apply to State and Territory Governments • We need wider support from others - you

  33. Whose problem? • Increasingly, interoperability is required as well as functionality • Each time an idiosynchratic local decision is made, interoperability gets harder

  34. Whose problem? • Ours – yours, mine • Standards – part of the main game in eHealth and health system reform • There’s lots in it for organisations • And for individuals, as part of a knowledge network

  35. Standards – the main game in eHealthPlease play! David.Rowlands@standards.org.au Elizabeth.Hanley@standards.org.au www.e-health.standards.org.au

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